针刺治疗偏头痛抑郁/焦虑障碍心身同调效应机制研究

Migraine, a commonly-encountered primary headache which is often associated with depression or anxiety, is a typical psychosomatic disease. However, effective therapies for migraine associated with depression/anxiety are limited at present. Adverse reactions are common in medication, and drug abuse as well as drug dependence are arising. Meanwhile, widespread and normative approaches of psychotherapy are still inadequate. It has been approved by clinical practice that acupuncture is a very effective way to relieve migraine and its accompanied psychiatric disorders. Under the view of physical and mental integration, acupuncture shows its unique advantages in a comprehensive effect of both headache relieving and psychological adjusting without side-effects. However, its mechanism is still unknown. In this study, non-invasive event related potentials (ERP) is adopted to tell the superior psychological activity of the brain constantly. Taking migraine patients with depression or with depression and anxiety as the study object, neurological functions and psychological activities are evaluated by psychological scale with the help of ERP technology to study the mechanism of the psychosomatic effect of acupuncture on migraine with depression or anxiety disorders. Therefore, analysis on mechanism of psychological adjusting and effective relieving headache of acupuncture can be carried out simultaneously. And it is expected to provide clinical evidences for explaining the way of acupuncture in treating psychosomatic diseases.

偏头痛是常见的原发性头痛，常伴见抑郁/焦虑障碍，是典型的心身疾病。目前偏头痛抑郁/焦虑障碍的治疗手段有限，药物治疗不良反应多，且出现药物滥用、药物依赖现象；而心理治疗，又缺乏普及、规范的治疗途径。以往的临床实践表明针刺缓解此类偏头痛有很好的疗效。尤其是在“形神合一”观指导下的针灸疗法，可在有效缓解头痛的同时，改善患者的心理状态，显示出既无毒副作用又综合调理的独特优势，但其作用机制尚未明了。本研究采用事件相关电位（ERP）实时无创反映大脑高级心理活动，将神经功能活动状态和心理活动相结合，以偏头痛抑郁或偏头痛抑郁伴焦虑障碍患者为研究对象，借助ERP技术，结合心理量表，开展针刺对偏头痛抑郁/焦虑障碍患者心身同调效应机制研究，观察针刺在有效缓解偏头痛的同时，研究分析其通过何种机制改善患者的心理状态。为科学诠释针刺治疗心身疾病的途径提供临床依据。

背景：偏头痛常伴见抑郁/焦虑障碍，是典型的心身疾病，目前治疗手段有限，药物治疗不良反应多，又缺乏普及规范的心理治疗途径。针灸既无毒副作用，又心身同治，治疗本病具有独特的优势。.主要研究内容：本研究以偏头痛抑郁/焦虑障碍患者为研究对象，接受每周2次，共计8周的五行针灸治疗，同时以匹配的健康受试者为对照。借助事件相关电位（ERP）技术，结合心理量表（HAMD、HAMA、五态人格量表、艾森克人格量表），对大脑神经电生理功能失衡的程度与头痛程度、抑郁/焦虑程度、不同人格特征的相关性进行分析。.重要结果：（1）五态人格问卷显示：患者主要分布在太阴型（64.71%），健康受试者以少阳型（46.88%）、阴阳平和型（28.13%）为主，差异非常显著（P＜0.01）。患者五行主导一行以水为主。（2）艾森克人格问卷显示：患者与健康受试者在E维度（内向-外向）、N维度（稳定-不稳定）均差异非常显著（P＜0.01），患者较健康受试者更内向，更不稳定。（3）治疗后患者头痛影响测定量表总分（HIT-6）、HAMD分值、HAMA分值、头痛发作次数、头痛发作时严重程度、头痛发作持续时间、头痛时伴随症状、头痛严重程度计分总分、头痛发作天数、VAS、止痛药服用次数等均显著下降，差异均有统计学意义（P＜0.05）。（4）患者治疗后脑诱发电位P300 在FZ、F3、F4的靶潜伏期均显著下降，差异有统计学意义（P＜0.05）；在FZ观测到的P300靶刺激潜伏期与HAMA分值明显相关（P＜0.05）。.科学意义：本研究提示：五行属太阴主导，人格特征情绪不稳定者更容易患偏头痛抑郁/焦虑障碍。五行针灸可在有效缓解头痛的同时，缩短患者P300潜伏期，改善患者的认知，缓解焦虑，调整其心理状态，达到心身同治的目的。